The JAK-STAT pathway is critical in ventilator-induced diaphragm dysfunction

Mol Med. 2015 Feb 19;20(1):579-89. doi: 10.2119/molmed.2014.00049.

Abstract

Mechanical ventilation (MV) is one of the lynchpins of modern intensive-care medicine and is life saving in many critically ill patients. Continuous ventilator support, however, results in ventilation-induced diaphragm dysfunction (VIDD) that likely prolongs patients' need for MV and thereby leads to major associated complications and avoidable intensive care unit (ICU) deaths. Oxidative stress is a key pathogenic event in the development of VIDD, but its regulation remains largely undefined. We report here that the JAK-STAT pathway is activated in MV in the human diaphragm, as evidenced by significantly increased phosphorylation of JAK and STAT. Blockage of the JAK-STAT pathway by a JAK inhibitor in a rat MV model prevents diaphragm muscle contractile dysfunction (by ~85%, p < 0.01). We further demonstrate that activated STAT3 compromises mitochondrial function and induces oxidative stress in vivo, and, interestingly, that oxidative stress also activates JAK-STAT. Inhibition of JAK-STAT prevents oxidative stress-induced protein oxidation and polyubiquitination and recovers mitochondrial function in cultured muscle cells. Therefore, in ventilated diaphragm muscle, activation of JAK-STAT is critical in regulating oxidative stress and is thereby central to the downstream pathogenesis of clinical VIDD. These findings establish the molecular basis for the therapeutic promise of JAK-STAT inhibitors in ventilated ICU patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adenosine Triphosphate / metabolism
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Diaphragm / metabolism*
  • Diaphragm / physiopathology
  • Gene Expression Profiling
  • HEK293 Cells
  • Humans
  • Janus Kinases / metabolism*
  • Membrane Potential, Mitochondrial
  • Middle Aged
  • Oxidative Stress
  • Rats, Sprague-Dawley
  • Respiration, Artificial / adverse effects*
  • STAT Transcription Factors / metabolism*
  • Signal Transduction

Substances

  • STAT Transcription Factors
  • Adenosine Triphosphate
  • Janus Kinases